Depression can impact how a person functions, as it can affect the way you feel, think, and act. To be diagnosed with major depressive disorder (MDD), a person must have symptoms that last most of the day, almost every day, for at least two weeks in a row.
Nearly 3 in 10 U.S. adults, or 29%, have been diagnosed with MDD. Experts believe the actual number of Americans with depression is even higher, since many people don’t get diagnosed.
Psychiatric providers can diagnose depression, make a treatment plan, and prescribe medication if needed.
Life can be hard, and everyone feels sad sometimes. However, if you’ve been feeling low for two weeks or more and have lost interest in things that once brought you joy, it could be a sign of depression.
Depression doesn’t look the same for everyone. You may have trouble focusing at work or feel too tired to do chores at home. Maybe you stop wanting to see friends, or you lie awake at night unable to sleep. No matter what you’re feeling, know that you’re not alone. Talking to a psychiatric provider about these challenges could be helpful.If you’ve ever wondered how a psychiatrist diagnoses depression, here’s what you can expect.
When to seek a psychiatric diagnosis for depression
When you’re experiencing depression, several genetic processes as well as environmental stressors are involved. This can trap you in a cycle of negative thoughts and make it harder to manage emotions. Depression isn’t a weakness, and you can’t just “snap out of it.” It’s a common and manageable mental health condition.
If you aren’t sure what’s going on, seeing a primary care doctor is a good first step. They can check for depression and rule out other health problems. They can also refer you to a psychiatrist for more specialized help.Psychiatrists are medical doctors, while psychiatric mental health nurse practitioners (PMHNPs) are nurse practitioners who focus on mental health. They can make a treatment plan that may include therapy, medication, or both. They can also help with treatment-resistant depression.
Symptoms of depression can include:
Changes in sleeping patterns
Loss of interest in things you once enjoyed
Feeling down most days
Feelings of guilt and worthlessness
Having suicidal thoughts or thoughts of harming yourself *
Having trouble concentrating or remembering things
Depression symptoms can also be physical, like frequent headaches or digestive problems including low appetite.
*A note on safety: The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. If you’re experiencing a life-threatening emergency or you need immediate help, please call 911.
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How psychiatrists diagnose depression
Depression can be hard to diagnose since the symptoms often vary from person to person. While some people may feel sad or hopeless, others might feel irritable or angry. Depression symptoms often develop gradually, making it hard to recognize when something is wrong.
To diagnose depression, a psychiatrist will usually:
Evaluate your symptoms. A psychiatric provider will ask about things like your sleep patterns and overall mood. They will also want to know how severe your symptoms are, how long they’ve lasted, and how they’re affecting your daily life.
Rule out other causes. Depression shares symptoms with other medical conditions, like thyroid disorders and vitamin deficiencies. Doctors may order blood work to rule out these other causes.
Use a diagnostic tool. Psychiatrists often refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to this manual, a diagnosis of depression requires at least five symptoms that have lasted for at least two weeks and cause noticeable changes in how you feel or act. Psychiatric providers may also use additional screening tools to ensure you have an accurate diagnosis.
A psychiatrist may diagnose you with one of the following types of depression:
Major depressive disorder (MDD): MDD is characterized by a low mood that lasts most of the day, nearly every day, for at least two weeks. It can affect how you handle work, school, or relationships.
Persistent depressive disorder (PDD): PDD is a chronic, low-level depression that lasts for at least two years. Symptoms can include poor appetite, low energy, and feelings of hopelessness. While the symptoms aren’t as intense as MDD, they tend to last longer. PDD and MDD can also occur together.
Postpartum depression: This form of depression happens during pregnancy or after childbirth. It can involve sadness, anxiety, extreme tiredness, and trouble bonding with the baby.
Bipolar disorder: There are different types of bipolar disorder, but they all involve extreme changes in mood. People with bipolar disorder may go through episodes of mania or hypomania as well as periods of sadness, low energy, and hopelessness.
Seasonal affective disorder (SAD): People with SAD experience a drop in mood when the seasons change. It’s more than just the “winter blues.” SAD can affect mood, sleep, energy, and appetite, making life feel overwhelming.
Premenstrual dysphoric disorder (PMDD): This severe form of premenstrual syndrome (PMS) is characterized by intense physical and emotional symptoms in the week before a menstrual period. It can lead to mood swings, tension, sleep problems, and more.
After your diagnosis, your psychiatric provider will:
Develop a treatment plan: Based on the severity of your symptoms, your medical history, and personal preferences, you’ll work with your psychiatric provider to create a treatment plan. This might include cognitive behavioral therapy (CBT), lifestyle changes like stress management, exercise and nutrition tips, and medication if needed.
Provide education: They will explain how treatment works, when you might expect to feel better, and any side effects if you’re prescribed medication.
Schedule follow-up appointments: Your psychiatrist will tell you how often you should meet for appointments, monitor your progress, and adjust medication as needed.
Coordinate care (if needed): They may suggest group therapy or a support group. They can also work with your primary care provider or other specialists.
What to know before your appointment
If you’ve never seen a psychiatric provider, you might be unsure what to expect. At your first appointment, you’ll be asked about your medical history, current medications, and symptoms of depression. Everything you say is private, and being honest can help them understand what you’re going through. Psychiatric providers are there to help, not judge.
It's also a good idea to ask questions during your visit. This can help you feel more comfortable with your treatment plan. You might ask:
What might be causing my symptoms?
What are my treatment options?
Will I need medication? If so, are there side effects?
How long will it take before I begin to feel better?
How often should we schedule appointments?
A depression diagnosis can often happen during the first appointment. If there’s a chance that your symptoms have a physical cause, like thyroid problems or vitamin deficiencies, your psychiatric provider may order blood work, which can take a few days to a week for results. If your symptoms are unclear or co-occurring with other conditions, like ADHD or anxiety, they may need more than one visit to assess you.
If someone is worried that their symptoms aren’t ‘bad enough’ to warrant a depression diagnosis, I would tell them that depression is a spectrum where all symptoms can impact a person's daily functioning. If a person feels that their depressive symptoms are impacting them, they should seek care.
Halee Fullerton, PMHNP-BC
Clinical reviewer
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Living with depression can be hard. Just getting through the day can leave you feeling tired, sad, or hopeless. But it’s important to remember you’re not alone, and help is available. Talking to a psychiatric provider can help you better understand your feelings and find healthy ways to cope and feel better.
At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best.
Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we're here to help you make progress — wherever you are on your mental health journey.
Linda Childers
Linda is an award-winning medical writer with experience writing for major media outlets, health companies, hospitals, and both consumer and trade print and digital outlets.
Her articles have appeared in the Washington Post, USA Today, WebMD, AARP, Brain+Life, HealthyWomen.org, The Rheumatologist, California Health Report, Everyday Health, HealthCentral, and many other media outlets.
While juggling the responsibilities of being part of the “sandwich generation” and caring for both her toddler son and terminally ill mother, a nurse friend encouraged her to seek therapy, which helped her to learn coping strategies and manage her depression. Linda hopes her work will help to destigmatize mental health conditions and encourage others to get the help they need.
Halee Fullerton, PMHNP-BC
Halee is a psychiatric nurse practitioner with experience treating children, adolescents, and adults. She has worked in outpatient community health with children/adolescents as well as inpatient substance use disorder treatment. She currently sees patients via outpatient telehealth. Before becoming a psychiatric nurse practitioner, she worked in emergency rooms, medical-surgical units, long-term care facilities (including Alzheimer/dementia units) and the intensive care unit.
She chose a career in mental health because she wanted to help people and to contribute to breaking down stigma around mental health. She is especially passionate about working with people who are navigating substance use disorders, depressive disorders, and anxiety/trauma-related disorders. She has three labradoodles that she adores.
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